Prevention and management of spouting bleeding during endoscopic submucosal dissection for large subpedunculated type colonic tumor

Abstract

Endoscopic submucosal dissection (ESD) is a reliable method for treating superficial colorectal tumors, however it is technically more difficult and requires more experience than gastric ESD, because of difficulties associated with endoscope operability and the anatomical features of the colorectal region, including the presence of folds/flexures, bending of the intestinal tract, and the thinness of the intestinal wall.¹ Main accidental complications during colorectal ESD are perforation and bleeding.^{2, 3} With continued bleeding, the visibility of the operative field would deteriorate. In addition, with the recent rise in the number of elderly individuals, the rate of comorbidities, including cardiovascular and cerebral vascular diseases has been increasing in Japan.

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